And the plan is.......

Discussion in 'General Parenting' started by Andy, Apr 3, 2009.

  1. Andy

    Andy Active Member

    We like the psychiatrist. He really explained things well and listened to what we had to say. He made sure that we were comfortable with this plan. He had reviewed difficult child's file and went over everything with us.

    difficult child will go back on the Flouxetine since it worked in the past. Just not as high a dose. The psychiatrist was surprised he was kept on as high a dose as he was. He said the tremors difficult child had in his hands were more likely caused by too high a dose of the Flouxetine instead of the clonazepam. difficult child will start out with 10 mg per day and go from there. psychiatrist is guessing that 15 mg may be the dose he ends up with.

    That is for the anxiety.

    For the panic attacks and school refusal: Propranolol. Until the Flouxetine gets to where it needs to be, the Propranolol will be taken mornings that he goes to school and mornings of anxiety events. This is a short lived 4 hour tablet.

    difficult child will take 10 mg tomorrow morning when he gets up and find activities such as playing outside, running around ect. to test how it will effect him. Then about 4 - 6 hours later take another 10 mg to test it again.

    On Sunday morning, difficult child will take 20 mg to test it and another 20 in the afternoon.

    He is to compare the two doses and if he can tolerate the 20 mg we will go with that strength for now to battle the school refusal he is quickly heading toward.

    Once the Flouxetine is up to effectiveness, the Propranolol will become a PRN for more anxious times/panic attacks.

    I think it is so weird. Remember how at first I was hoping for a PRN and then as difficult child became worse again and listening to wisdom of this board, I resigned to full time medications. Now I get both.

    So, I filled those prescriptions plus an eye drop prescription from the eye doctor for difficult child. I need to call the Pharmacy tomorrow - they were closing as I zoomed in to pick these up and I didn't take time to look at the co-pays: Maybe one of you can tell me if this makes sense (I hope not though):

    Pataday - eye drops - bottle so tiny you could loose it - $86.63
    Ins paid $70.83 and I pay $16.00

    Propranolol 20 mg tablets - 30 tablets - $2.98
    Ins paid nothing - I pay it all

    Fluoxetine - 10 mg - 90 pills - $20.40
    Ins paid nothing - I pay it all

    psychiatrist stated Fluoxetine was very inexpensive - you could get it for $5 at Wal-Mart (I will have to check into that). However, I know insurance paid for it in the past. I can't imagine it being taken off the covered list.

    I am wondering if the lables got mixed up? Maybe the Pataday is $2.98, The Propranolol is $86.63, and the Fluoxetine could be right since it is a three month supply?
  2. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    I know nothing about the price of those medications. Sorry!

    Good news for your kiddo, I hope. Prozac had a bad effect on me, but everyone is different. SSRIs can be good for anxiety. Paroxatine is magic for me, although a lot of people can't take THAT. It's very individual.

    I loved and still love Clonazapen. It has never given me any side effects at all, except tiredness if I felt nervous and took one during the day (I usually stuck to night). I never cared for blood pressure/heart slowing medications. They made me feel very spaced out and out of it, so keep an eye on your boy and see how he does. Again, we are all very different in our responses. I'm paranoid about feeling "out of it" so those medications actually increased my anxiety.

    Although they are habit forming, benzos are the only anxiety medications that really help me, along with my Paroxatine, and I don't really care if they are habit forming as I know I'll have to take them all my life or be incapacitated.

    Again, I wish you good luck. Your kiddo so reminds me of when I was his age. I hope the Prozac stops that Obsessive Compulsive Disorder (OCD) thinking that goes around in your head when you obsess about your health. That's so horrible to live through.

    Keep us all updated!!!
  3. flutterby

    flutterby Fly away!

    The propranolol would be the cheapest. It's a beta blocker (blood pressure medication) and it's been around a long time. I'm wondering if they didn't pay for the prozac (can't spell the generic) because it was prescribed for 90 days. Most insurance companies will only pay for a month at a time.

    I'm thinking 4-6 hours is awfully fast for the next dose of propranolol, but that's just me. Patients with high blood pressure take it twice a day - 12 hours apart. Pay attention to if he gets sleepy or lethargic - it could mean his BiPolar (BP) and/or pulse are dropping. It is useful for anxiety. Tremors, too.
  4. Jena

    Jena New Member

    do you feel a little better now? i hope so. hopefully you wont' have to use the other in that way once he gets the daily medication for the anxiety.

    how does he feel about it? i'm glad you liked the dr. that is good
  5. Andy

    Andy Active Member

    Thank you!

    Midwest - Clonazepam became a disinhibitive for difficult child. It got him into big trouble at school. He talked back to the teachers and could not tolerate normal behaviors of his classmates - got annoyed very easily. I think it has that effect more on kids who have not matured enough to recognize their impulses? The Prozac was a godsend for us so I am looking forward to it helping again.

    Flutterby - Thank you! $87 for a little bottle of eye drop is so high. I think we will be sticking with Claritin. I thought the eye doctor gave us a sample bottle it was so small and only lasted about one week or two. Then the prescription came in the exact size bottle! Wow! As for the Propranolol, there are a few ways of serving it up. psychiatrist stated that if we find we need it more often then once a day, we can look at getting the longer release form. So, those who take it twice a day for 12 hour intervals probably have a different form. difficult child has 10 - 20 mg to last 4 - 6 hours. I also wonder if they would need a stronger dose if it is used specifically for blood pressure? I don't know. I will take your advise and watch for sleepy/lethargic.

    Jena - Yes, I feel much much better and at the same time a little nervous about the next few weeks as we work through this. difficult child sees the therapist on Wednesday and then both therapist (2:30) and psychiatrist (3:30) the last Friday in April (let's hope the predicted flooding for later in the month does not interfere. But atleast we have been seen and psychiatrist can do things via phone if need be.

    psychiatrist took special notice of difficult child being just a tad on the slow side of reading. difficult child states he can't remember what he reads thus does not like to read. Nothing indicates a learning disability but the day is still young, we can still figure out what this means. psychiatrist did not address it at this point. I will ask him or therapist about it on our next visit.

    I told psychiatrist that I wanted to look at anything else going on besides anxiety and panic because those were diagnosed under acute admission so I don't think much time was spent outside of treating that.
  6. susiestar

    susiestar Roll With It

    Sounds like a good plan. I like having the prn as well as the daily medication. It gives you a lot more ability to meet changing needs.

    The fluoxetine is prozac and you can get a 90 day supply for $10 at the Walmart pharmacy, or a one month supply for $4. The propranolol is priced the same, I am pretty sure.

    Sadly, pataday is the "latest and greatest" allergy eye drop and that IS the price for a teeny bottle of it. The docs all like to rx it because it is what the reps are pushing. There are a lot of other eye drops out there though, so you may not want to stay with this one. husband and the boys all get terrible allergy eyes, but they respond well to some of the OTC allergy eye drops. There is one WalMart carries in a house brand, opcon A or something similar that has worked as well as the more expensive rx drops.

    I would call the eye doctor about other alternatives or else the prescription assistance program if you don't have coverage for prescriptions. While our eye doctor RAVES about pataday, she says that it really is only a little bit better than opcon a drops. It just gets raved about because it seems to help that very small % of the population that doesn't respond to other allergy medications.

    I really hope the prozac and inderal (propran) work. I find the inderal to be an itneresting choice as it is a blood pressure medication (beta blocker) and is used to prevent migraines. But it does sort of take the edge off if you are highly wound and have not taken it often. You do adjust to the sedating property with-in a few weeks, so it may be less effective and need to be reviewed at that time.

    I hope he feels better soon!
  7. Andy

    Andy Active Member

    Thank you Susiestar!

    The more I think about this, the more I think I remember vision doctor telling me in previous visits that this was expensive. They are now pushing it based on, "Other allergy medications dry things up too much." Fortunately this was only $16 for us and I will not be refilling it.

    I am getting the most out of the new medication. difficult child was told to be active this morning so we can see if it has any effects. He doesn't want to get dressed and play outside (part of his separation anxiety - what if something happens and mom will not know?) so, I am getting him to do a variety of chores around the house! hehehe He brought up empty laundry containers from the basement and is now crushing cans. Hmmmm, I need to think of more. Maybe I can have a clean house by the time this is over?

    I like that it also helps prevents migraines. He needs that. It was a migraine that threw him into this episode of panic/anxiety.

    For the panic disorder, psychiatrist explained that it will slow the "fear factor" of the heart starting up adding to the panic/anxiety.

    I am very grateful for everyone's insight on the propranolol. I think it will be best if I can keep it on the PRN level once the Flouxetine kicks in.
  8. SomewhereOutThere

    SomewhereOutThere Well-Known Member

    Andy, good luck with all the medications.
    I think that him not wanting to be away from you is part of the hypochondria rather than separation anxiety. I think he's thinking, "What if I have a heart attack and Mom isn't there and nobody helps me and I die?"
    I hope this combo works for him. You may also want to teach him how to slow down his own heart. That helped me a lot. Course I was an adult when I learned that you can't panic if your heart isn't racing, if your breathing is slow, if your flight response isn't out of whack and a person CAN control that. I think about that when I feel a panic attack coming on.

    Curious question: Do fluorescent lights bother your son? They used to give me really bad panic attacks. I didn't like to go into stores that used them. Of course, now that's ALL And I can handle them now.
  9. DDD

    DDD Well-Known Member

    I am so glad that you got the appointment and feel comfortable with the medical professional. Fingers crossed that all goes well. Getting the right combo going is like watching a miracle! DDD
  10. Andy

    Andy Active Member

    Thank you!

    I am awaiting that miracle DDD.

    I don't see any effects from the 10 mg propranolol. difficult child said he still has the fears but doesn't have the feeling - if that makes sense? I think it does - he is looking for fear at this point. He gets afraid because he is not afraid. Can you tell I am getting very weary of this big time?

    I suppose it is an o.k. thing though. Now that he feels he is getting help, he will lay all his sorrows out in hopes they will be solved.

    He doesn't seem effected by flourescent lights. Maybe once in awhile - I get bothered by them every now and then but what sets me off is a crowded store - I can not handle chaotic movements. How are all those people so excellent in knowing just the perfect spot to block an aisle? Ever notice an inch one way or the other and the aisle would be open?

    I feel so stupid right now. psychiatrist asked if difficult child gets stuck on one thing and because my short memory doesn't work and I didn't understand the extent, I said "no". I never thought that the entire subject of health would count. I was thinking of just one thing at a time which he does get over and moves to the next. Midwest, you opened my eyes that I need to deal with the hyprochondria as a whole and stop fighting the individual battles thinking that will help. I think this has been brought to my attention before but I am a slow learner and didn't get it. Thank you so much for bringing it up again. I wasn't thinking of it as a seperate issue but I think I need to.

    Now I also see that he is stuck in his thoughts on one subject to the point where I am so close to screaming at him. I just want him to shut up and go away! Why? Because he is afraid he is going to forget what I look like (it would be funny if it wasn't so intrusive of my short personal space) so he is near me every other second to make sure I still look "right". How would you feel to have a 12 yr old face pop into your view at any given second and sometimes accompanied by the inquiry, "Mom?" I am going to bring it up on Wed at therapist appointment. Go ahead and laugh. It really is funny. Who in their right mind would worry about forgetting what I look like? It would be a blessing, not a curse. This is one of our precious difficult child activities that drive us nuts but is funny to watch.

    Actually, I am suppose to call the psychiatrist on Monday to report which dose difficult child will use. I will leave a message regarding this.

    I have a feeling that psychiatrist and therapist will work closer together than therapist and pediatrician doctor did.

    Oh, the pharmacy asked about a deductible. Deductibles on prescriptions are so stupid! I don't remember in the past that prescriptions were part of the deductible.
  11. tiredmommy

    tiredmommy Site Moderator

    Andy- We keep eye wash in the house for Duckie's allergies (& emergencies). We find it helps to wash her eyes and use nasal saline spray daily during peak allergy times.